Active NPI
John Mutone
- Pharmacist
- Middletown, NY
National Provider Identifier
1356506661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 30941-1
- Practice address
- 20 Lloyds LN
Middletown, NY 10940-3132 - Phone
- (845) 341-2107
- Fax
- (845) 341-2123
- NPI assigned
- Jul 25, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 30941-1 | NY | Primary |
Addresses
Primary practice location
20 Lloyds LN
Middletown, NY 10940-3132
Mailing address
20 Lloyds LN
Middletown, NY 10940-3132
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01369539 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30941-1 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoprite Supermarkets Inc. | Past | Accepting new patients | |
| Shoprite Supermarkets, Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba ShopRite Pharmacy of Wallkill
- Community/Retail Pharmacy
- Middletown, NY
- NPI 1629268875
-
dba Shoprite Pharmacy of Monticello
- Community/Retail Pharmacy
- Monticello, NY
- NPI 1508971383
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220918400000",
"number": "1356506661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 LLOYDS LN",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109403132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 LLOYDS LN",
"city": "MIDDLETOWN",
"state": "NY",
"postal_code": "109403132",
"telephone_number": "845-341-2107",
"fax_number": "845-341-2123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTONE",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-25",
"last_updated": "2008-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "30941-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01369539",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Middletown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.